HPA axis regulation in posttraumatic stress disorder: A meta-analysis focusing on potential moderators

Schumacher, Sarah; Niemeyer, Helen; Engel, Sinha; Cwik, Jan Christopher; Laufer, Sebastian; Klusmann, Hannah; Knaevelsrud, Christine

doi:10.1016/j.neubiorev.2019.02.005

Cited by 86 publications

(51 citation statements)

References 45 publications

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“…Although a short-term hyperactivity of the sympathetic nervous system does not lead to any serious health-related consequences, the prolonged hyperactivity of the stress-related hypothalamic-pituitary-adrenal axis might lead to fatigue, depression, and other health-related outcomes [ 37 , 38 , 39 ]. As demonstrated by studies on previous outbreaks [ 40 , 41 ], some of the medical workers during the SARS-CoV-2 pandemic may be at risk for post-traumatic stress disorder, which also appears to be connected with prolonged hypothalamic–pituitary–adrenal (HPA) axis overactivity [ 42 , 43 ]. From a psychodynamic perspective, prolonged emotional tension can lead medical workers to channel difficult emotional experiences into somatic symptoms and insomnia, which are easier for them to accept than developing depressive symptoms that may lead to an occupational dysfunction and could be understood as the effect of defense mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Mental Health of Medical and Non-Medical Professionals during the Peak of the COVID-19 Pandemic: A Cross-Sectional Nationwide Study

Maciaszek

Ciułkowicz

Misiak

et al. 2020

JCM

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Background: The study aimed to compare psychopathological expressions during the COVID-19 (novel coronavirus disease 2019) pandemic, as declared on March 11th 2020 by the World Health Organization, with respect to which institutional variables might distinguish the impact of COVID-19 in medical and non-medical professionals. Methods: A cross-sectional study was performed nationwide between 16th March and the 26th April 2020 in Poland. A total of 2039 respondents representing all healthcare providers (59.8%) as well as other professionals filled in the sociodemographic section, the General Health Questionnaire-28 and the author’s questionnaire with questions related to exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the availability of protective measures, quarantine, change of working hours and place of employment during the pandemic, as well as feelings associated with the state of the pandemic. Results: Medical professionals more often presented with relevant psychopathological symptoms (GHQ-28 (General Health Questionnaire-28) total score >24) than the non-medical group (60.8% vs. 48.0%, respectively) such as anxiety, insomnia and somatic symptoms even after adjustment for potential confounding factors. Male sex, older age and appropriate protective equipment were associated with significantly lower GHQ-28 total scores in medical professionals, whereas among non-medical professionals, male sex was associated with significantly lower GHQ-28 total scores. Conclusions: Somatic and anxiety symptoms as well as insomnia are more prevalent among medical staff than workers in other professions. Targeting the determinants of these differences should be included in interventions aimed at restoring psychological well-being in this specific population. Apparently, there are present gender differences in psychological responses that are independent of profession.

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Section: Discussionmentioning

confidence: 99%

Mental Health of Medical and Non-Medical Professionals during the Peak of the COVID-19 Pandemic: A Cross-Sectional Nationwide Study

Maciaszek

Ciułkowicz

Misiak

et al. 2020

JCM

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“…Due to increased levels of CRH and ACTH, the adrenal gland secretes cortisol that feedbacks negatively to the hypothalamus to inhibit the release of ACTH and CRH further and initiate the fight and flight response. However, in the case of PTSD, there is blunted ACTH responses leading to reduced cortisol secretion and impaired negative feedback to the hypothalamus (Figure 3) [50]. This stress dysregulation is both physiological and psychological.…”

Section: Genetic Differences In Ptsdmentioning

confidence: 99%

Genetic and Neuroimaging Approaches to Understanding Post-Traumatic Stress Disorder

Nisar

Bhat

Hashem

et al. 2020

IJMS

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Post-traumatic stress disorder (PTSD) is a highly disabling condition, increasingly recognized as both a disorder of mental health and social burden, but also as an anxiety disorder characterized by fear, stress, and negative alterations in mood. PTSD is associated with structural, metabolic, and molecular changes in several brain regions and the neural circuitry. Brain areas implicated in the traumatic stress response include the amygdala, hippocampus, and prefrontal cortex, which play an essential role in memory function. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD and other stress-related psychiatric disorders. Conventional methods of studying PTSD have proven to be insufficient for diagnosis, measurement of treatment efficacy, and monitoring disease progression, and currently, there is no diagnostic biomarker available for PTSD. A deep understanding of cutting-edge neuroimaging genetic approaches is necessary for the development of novel therapeutics and biomarkers to better diagnose and treat the disorder. A current goal is to understand the gene pathways that are associated with PTSD, and how those genes act on the fear/stress circuitry to mediate risk vs. resilience for PTSD. This review article explains the rationale and practical utility of neuroimaging genetics in PTSD and how the resulting information can aid the diagnosis and clinical management of patients with PTSD.

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“…Stress system (dys)function is commonly measured via (neuro)endocrine parameters of the HPA axis, predominantly cortisol and/or ACTH. First, meta‐analyses on basal and challenged cortisol levels (e.g., Klaassens, Giltay, Cuijpers, van Veen, & Zitman, ; Schumacher, et al, ) did not confirm consistent differences between PTSD and non‐PTSD individuals or between trauma‐exposed individuals and controls. Considering the numerous moderators of cortisol responses, salivary/blood cortisol may not be sensitive to trauma‐induced transformation of the HPA axis consequent to adverse experiences and across development.…”

mentioning

confidence: 99%

Psychophysiological approaches to understanding the impact of trauma exposure

Rockstroh

McTeague

2019

Psychophysiology

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HPA axis regulation in posttraumatic stress disorder: A meta-analysis focusing on potential moderators

Cited by 86 publications

References 45 publications

Mental Health of Medical and Non-Medical Professionals during the Peak of the COVID-19 Pandemic: A Cross-Sectional Nationwide Study

Mental Health of Medical and Non-Medical Professionals during the Peak of the COVID-19 Pandemic: A Cross-Sectional Nationwide Study

Genetic and Neuroimaging Approaches to Understanding Post-Traumatic Stress Disorder

Psychophysiological approaches to understanding the impact of trauma exposure

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